Gastric Varices and Hepatic Encephalopathy: Treatment with Vascular Plug and Gelatin Sponge–assisted Retrograde Transvenous Obliteration—A Primary Report

AbstractGastric fundal varices and portosystemic hepatic encephalopathy are major complications of portal hypertension in patients with liver cirrhosis. Many treatment options have been used for gastric varices, including endoscopic injection and transjugular intrahepatic portosystemic shunts (TIPS), but the clinical effectiveness of these treatments remains contentious. Today, balloon-occluded retrograde transvenous obliteration (BRTO) has become the treatment of choice because of its excellent clinical effectiveness and outcomes; however, the associated use of sclerosants and temporary indwelling balloon catheters can cause specific complications. Vascular plugs are another option that has been shown to be safe, feasible, and effective when used as an embolic material in vascular disease. Recently, a technique has been developed that uses such vascular plugs with a gelatin sponge to embolize gastrorenal shunts. This technique is known as plug-assisted retrograde transvenous obliteration (PARTO), and it is also associated with high technical and clinical success rates. Moreover, it appears to be a much safer and more feasible procedure than BRTO. In this review, we introduce PARTO and outline its strengths and potential for use as the treatment of choice in gastric varices and hepatic encephalopathy.

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Retrograde Transvenous Obliteration of Gastric Varices using Sodium Tetradecyl Sulphate: Technical Considerations and Results from a Single Institution Retrospective Study

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1728998 ◽

2021 ◽

Author(s):

Pushpinder S. Khera ◽

Pawan K. Garg ◽

Sarbesh Tiwari ◽

Narendra Bhargava ◽

Taruna Yadav ◽

...

Keyword(s):

Retrospective Study ◽

Clinical Success ◽

Gastric Varices ◽

Early Recurrence ◽

Single Institution ◽

Vascular Plug ◽

Acute Bleeding ◽

Sclerosing Agents ◽

Age Range ◽

Refractory Hepatic Encephalopathy

Abstract Introduction Retrograde transvenous obliteration (RTO) with the assistance of a balloon (BRTO) or a vascular plug (PARTO) is an established method for treating gastric varices (GVs) secondary to portal hypertension. Most of the available studies on RTO have used lipiodol along with sclerosing agents like ethanolamine oleate or sodium tetradecyl sulfate (STS). We evaluated the safety and efficacy of RTO for treating GVs using STS as a sclerosant without lipiodol. Materials and Methods Sixteen patients (nine men, age range 16–74 years) were included in this retrospective study. Twelve patients presented with acute bleeding, two with chronic bleeding, one with large varices without bleeding, and one with refractory hepatic encephalopathy (HE). BRTO was attempted in 14 patients and PARTO in 2 patients. The technical and clinical success and complications of RTO were studied. Results The RTO procedure was technically successful in 14 (14/16, 87.5%) patients, with 13 (13/14, 93%) obtaining clinical success. One patient died due to the early recurrence of bleeding. Three patients had minor intraprocedural complications. Conclusion Retrograde gastric variceal obliteration using STS is safe and technically feasible with high technical and clinical success and low complication rate.

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